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Editor's blog Monday 1st February 2010: What the hell is going on?

Hello again. Normal service is likely to be resumed hereafter. Today we have fresh Maynard Doctrine for you, with the good Professor launching into Clinical Excellence awards with righteous vigour. They do not emerge unscathed.

So, what the hell is going on more generally?

Why has David Cameron just performed a stonking great policy U-turn on cutting the deficit?

A biggie, that one (and leaving the field for the Lib Dems). But far from the only one.

I mean, can anyone tell me what the fuck Sir David Nicholson and company in the DH are doing about the community services announcement?

Everybody now knows SHAs have been telling PCTs to tell people working in community providers to choose between being employed by the local acute trust or the mental health trust. The only slight problem being that nothing is official. There is no guidance.

Now in our recent Bill Moyes interview, he told me, "there's a desperate need for clarity from the DH on the future of community provision ... (David Nicholson's) right not to entrench community services in their current format: that would create no incentive to change the way they work ... we really need the next stage of policy: a picture of how community services are to be funded, managed, performance-managed and what they will be expected to deliver in productivity, quality and accessibility".

Moyes is right, in spades. We have the clarity of mud on this issue. Nicholson's - and the DH's - volte-face on (or many would argue, utter unseriousness about) the potential for community FTs and social enterprises has led the more adventurous up the garden path. The less adventurous are simply noting that when it comes to command-and-control, then the stated NHS principles of innovation (remember that one?) and looking out to your community, not up to Whitehall merely reinforce La Rouchefoucauld's classic dictum that "hypocrisy is the hommage that vice pays to virtue".

Though obviously, Andy Burnhoid's "NHS preferred provider" speech sets a high benchmark for fundamental policy u-turns. Which should henceforth be referred to as 'doing a Burnham'.

Boy, do we ever need better government.

What do we know about community services? Not a lot: it's a bit like general practice before the QOF. Much is asserted, with little data.

So let's transpose the question: what do provider trusts know about community services? Any more than 'not a lot'? Very, very unlikely. The managers in the National Hospital Service have still startlingly rarely had much to do with what they see as the 'corduroy' world of PCTs and community services.

To change services, it is necessary to understand them. To change cultures is just the same. There is a sense not just of the absence of thought on this one, but of a panicky, headless-chicken rushing.

Pissing about with the employment relationship of people who work in community services smacks strongly of working on Yes, Minister's political syllogism: something must be done; this is something; therefore this must be done.

Bill Moyes made other interesting points, when he suggested, "there's been growing concern in the DH that community FTs could enshrine local monopolies: a concern with which I agree. I’d also be concerned that community FT inhibit acquisition of some services by FTs ... David Nicholson's view (as best I understand it) is that there is a lot of productivity to be gained by getting community services properly organised and managed, and I think he's right not to entrench community services in their current format: that would create no incentive to change the way they work".

What would be the difference between local monopolies of community FTs and local monopolies of all healthcare provision in acutes and FTs? Particularly in an NHS of seriously underwhelming commissioning.

This has not been thought through properly. To put it very mildly.

Elsewhere in the meeja
Couple of interesting bits: Grauniad has the Conservative FOI story in emergency readmisssions. Let's hope the lovely Straight Statistics people get into this data further. It looks to warrant some proper unpacking.

Yesterday's Observer has what looks like a comprehensive leak of the mid-Staffs report. Depressing reading it is likely to make.

And there need to be prosecutions on this one. It is a shameful and sad reflection of the culture and courage and integrity of managerial and clinical staff that what happened there was allowed to go on - in the main without serious challenge - for years. The Royal Colleges, professional societies and the NPSA should all take a hard look at themselves.

On a much-needed upbeat note, this, in the Independent, is a good news story.